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1型复杂性区域疼痛综合征:诊断与管理

Complex Regional Pain Syndrome Type 1: Diagnosis and Management.

作者信息

Lee Jae Won, Lee Sang Ki, Choy Won Sik

机构信息

* Department of Orthopedic Surgery, Eulji University College of Medicine, Daejeon, Korea.

出版信息

J Hand Surg Asian Pac Vol. 2018 Mar;23(1):1-10. doi: 10.1142/S2424835518300013.

Abstract

Diagnosis of Complex regional pain syndrome (CRPS) is made primarily on a clinical basis, and no specific test is known to confirm or exclude CRPS diagnosis. That is, there aren't specific diagnostic tools and instrumental tests are made only for identifying an etiology at the basis of the CRPS. Numerous therapeutic methods have been introduced, but none have shown definitive results. When symptoms persist, patients experience permanent impairment and disability. Therefore, early recognition of CRPS, along with proper treatment, is important for minimizing permanent loss of function. As there is no gold standard test for CRPS, several clinical diagnostic criteria have been introduced and applied in various studies. However, to date, no formal or standardized diagnostic criteria for CRPS have been widely accepted. However, the Budapest diagnostic criteria have recently increased in popularity and are frequently used in scientific studies. The goal for management of CRPS is the return of normal limb function. No specific technique has been shown to prevent CRPS following surgery, but avoidance of prolonged immobilization may be important. Therefore, initiating early post-surgical rehabilitation, where possible, is important. A multidisciplinary approach would seem to be optimal, above all things objectives of physical and occupational therapy are fulfilled with combination pharmacotherapy due to provide pain relief to facilitate physical rehabilitation. Future research using large randomized controlled trials should focus on collecting strong evidence for the etiology of CRPS, testing pharmacological effects, and determining appropriate combination treatment strategies.

摘要

复杂性区域疼痛综合征(CRPS)的诊断主要基于临床,目前尚无已知的特定检查可确诊或排除CRPS诊断。也就是说,没有特定的诊断工具,仪器检查仅用于确定CRPS的病因。已经引入了多种治疗方法,但均未显示出确切的效果。当症状持续存在时,患者会出现永久性损伤和残疾。因此,早期识别CRPS并进行适当治疗对于最大限度地减少功能的永久性丧失非常重要。由于没有CRPS的金标准检查,因此在各种研究中引入并应用了几种临床诊断标准。然而,迄今为止,尚未有正式或标准化的CRPS诊断标准被广泛接受。不过,布达佩斯诊断标准最近越来越受欢迎,并经常用于科学研究。CRPS管理的目标是恢复肢体正常功能。目前尚无特定技术被证明可预防术后CRPS,但避免长时间固定可能很重要。因此,尽可能尽早开始术后康复很重要。多学科方法似乎是最佳选择,最重要的是,物理治疗和职业治疗的目标通过联合药物治疗得以实现,因为药物治疗可缓解疼痛以促进身体康复。未来使用大型随机对照试验的研究应专注于收集关于CRPS病因的有力证据、测试药物效果以及确定合适的联合治疗策略。

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